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Coronary Sinus Catheter-Induced Heart Block During Aortic Valve Replacement: A Case Report
Aaron B Dahl1, Teresa Murray-Torres, Daniel A Emmert
1From the Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
Insights
Cardiac surgery can cause conduction abnormalities, sometimes requiring permanent pacemakers. This case highlights complete heart block after coronary sinus catheter placement in a high-risk patient with left bundle branch block and heart failure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Conduction abnormalities are frequent after cardiac surgery, with many resolving spontaneously.
- 1%-3% of patients necessitate permanent pacemaker implantation.
- Risk factors for permanent pacemaker include pre-existing conduction issues, reoperation, pulmonary hypertension, and mitral/aortic valve surgery.
Purpose of the Study:
- To report the first case of complete heart block following coronary sinus catheter placement in a patient with specific pre-existing conditions.
- To highlight potential risks in high-risk cardiac surgery patients.
Main Methods:
- Case report presentation.
- Review of patient's pre-operative conditions and post-operative complications.
Main Results:
- A patient with pre-existing left bundle branch block and reduced ejection fraction (25%) developed complete heart block after coronary sinus catheter placement.
- This represents a novel complication in the literature.
Conclusions:
- Coronary sinus catheterization can precipitate complete heart block in high-risk patients.
- Careful monitoring and consideration of pre-existing conditions are crucial in patients undergoing cardiac procedures.
Abstract:
Conduction abnormalities after cardiac surgery are common as is spontaneous resolution of these abnormalities. However, 1%-3% of patients will require placement of a permanent pacemaker. Patients with preexisting conduction abnormalities, undergoing reoperation, preexisting pulmonary hypertension and undergoing mitral or aortic valve operations are at a higher risk for requiring a permanent pacemaker. We present the first case described in the literature of a patient with a preexisting left bundle branch block, and heart failure with a reduced left ventricular ejection fraction of 25% who developed complete heart block after placement of a coronary sinus catheter.